Immigrants and Health Care

By Meredith King Ledford | August 16, 2007

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Before Congress recessed in early August, both the Senate and the House of Representatives passed legislation that would reauthorize the highly successful State Children’s Health Insurance Program, a program that provides health coverage to millions of low-income children. Hardline conservatives in the White House and Congress failed to defeat this progressive legislation. But undeterred, they are now falsely claiming that the House bill will allow undocumented immigrants access to public health insurance at the expense of tax paying citizens.

In fact the House bill, the Children’s Health and Medicare Protection Act, or CHAMP Act, included legislation that would give states the option to eliminate the five-year ban on eligibility for public benefits for all legal, documented immigrant children and pregnant women and would also ease some of the cumbersome administrative processes for providing proof of citizenship status when enrolling in Medicaid. Both of these policies would strengthen an already strong program—since the enactment of the program in 1997, the uninsured rate among children has decreased by one-third.

And so conservatives are once again spreading false rhetoric about undocumented immigrants and public health insurance in the hopes of bolstering public sentiment against the House’s proposal for SCHIP reauthorization. The most flagrant falsehood is the charge that the SCHIP bill passed by the House would enable undocumented immigrants to obtain Medicaid and SCHIP coverage.

The bill definitively does not remove the existing restrictions on undocumented immigrants’ access to Medicaid or SCHIP coverage. Undocumented immigrants are and will remain ineligible.

Yet the propaganda from the Bush administration and some conservatives attempts to perpetuate the canard that the House proposal would offer public services to undocumented immigrants at the expense of health care for senior citizens and other taxpayers. Some of the false allegations include:

“The administration is particularly concerned that the … dramatic liberalization of the citizenship documentation requirements would result in unacceptable increases in coverage under SCHIP for individuals who are currently not eligible for the program.”–Statement, Executive Office of the President, 8/1/07

“Again, the Democrats have proven their loyalty to illegal aliens over American citizens.”–Rep. Tom Tancredo (R-CO), New York Times, 8/1/07

These provisions will “provide even greater incentives for people to break our laws and enter our country illegally.”–Rep. Nathan Deal (R-GA), Press Release, 8/2/07

Clearly, facts are needed to ensure an objective debate takes place. The provisions in the House bill would actually accomplish the following:

Increase health coverage for low-income white and African-American children who have been most harmed by the 2006 proof-of-citizenship documentation requirement.

Currently: Documented immigrants have always been required to show documentation of their legal status to meet eligibility requirements for Medicaid under federal law. Yet on July 1, 2006, as part of the Deficit Reduction Act of 2005, a federal law was enacted requiring U.S. citizens to present proof of their citizenship and identity, such as U.S. passport or birth certificate, when they apply for Medicaid coverage or seek to renew their coverage.[1]

This law was enacted even though evidence showed that it was not needed. Mark McClellan, head of the Center for Medicare and Medicaid Services, noted that a report released by the Inspector General of Health and Human Services “does not find particular problems regarding false allegations of citizenship, nor are we aware of any.”[2]

But what the bill is actually doing is preventing tens of thousands of children who are U.S. citizens or documented immigrants from gaining public health coverage because their parents lack ready access to a passport or birth certificate. In fact:

The number of low-income children insured through Medicaid has dropped by 11,000 in Virginia and by14,000 in Kansas due to the new requirements; each state identified one applicant who incorrectly claimed to be a citizen.[3]

In Virginia, child Medicaid enrollment has declined by 4.3 percent among white children and by 5.0 percent among African-American children but increased by 4.4 percent among Hispanic children since the law took effect. If the provision was actually preventing undocumented immigrants from unlawfully enrolling in Medicaid, the coverage rate for Hispanic children would actually decline, since 80 percent of undocumented immigrants are of Hispanic origin.[4]

House Bill: The bill allows states greater flexibility in choosing how to ensure that children applying for Medicaid are citizens or eligible documented immigrants, thereby reducing federal and state administrative costs by allowing the use of more cost-efficient procedures in gaining proof of citizenship status. The National Association of State Medicaid Directors also called for such a change. Additionally, the bill requires that all states conduct annual audits to ensure that procedures continue to prevent undocumented immigrants from enrolling in the program. If a state audit finds that an undocumented or an ineligible documented immigrant is enrolled in Medicaid, that state would be required to fully repay the federal government for the costs of allowing undocumented immigrants to receive Medicaid.

Allow SCHIP or Medicaid coverage for documented immigrant children and pregnant women during the first five years in residence.

Currently: Permanent documented immigrants are eligible for public coverage but are subject to restrictions and stipulations. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 restricted documented immigrants arriving after August 22, 1996 from receiving federally-matched Medicaid coverage for their first five years in residence.[5] About one-quarter of the six million children who are uninsured and otherwise eligible for Medicaid or SCHIP are excluded because of immigration restrictions.[6]

House Bill: The bill includes a provision to give states the option to cover documented immigrant children and pregnant women in their first five years in the United States. This is a provision that the Senate approved on a bipartisan basis in 2003 as part of the Medicare prescription drug bill. It is also supported by the National Governors Association and the National Conference of State Legislatures. This provision does not make undocumented immigrants eligible for the SCHIP or Medicaid. In addition, any immigration reform that would legalize undocumented immigrants would set the parameters for benefits eligibility.

The reauthorization of the State Children’s Health Insurance Program is the first step in fixing the broken health care system. The program ensures that millions of low-income children have health care coverage and therefore have access to timely medical services. Any effort to increase health insurance coverage to the country’s vulnerable populations should reduce the barriers to health insurance for documented immigrants. But in order to do so, objective analysis of the policy options is needed to inform the debate. For more information on immigrants and health care, see: